Does Yoga Help RA?

The short answer is yes, research has demonstrated positive benefits of yoga for persons living with RA. In preparation for writing this article, I conducted a quick search (using terms rheumatoid arthritis and yoga) of research studies indexed in PubMed and came up with 25 entries. It was interesting that among those 25 entries, I discovered:

• a small number of the published articles were papers that detailed the protocols for future research studies (e.g., Evans, 2011; Middleton, 2013);
• a small number of the studies were pilot studies conducted to investigate the feasibility of conducting larger studies (e.g., Evans, 2010); 
• not many studies have been conducted which specifically investigate yoga and RA, with less than a handful being randomized, controlled studies; and 
• a significant number of the articles were actually reviews or meta-analyses of the small number of completed studies published within a certain time period (e.g., Telles, 2012).

How does yoga benefit persons with RA?

Here are some of the reported benefits of yoga in patients with RA seen during select clinical trials of various methods, outcomes, measurements, and duration.

Yoga helps to decrease:

• Disability
• Pain
• Depression
• Anxiety
• Fatigue
• Rheumatoid factor levels (reduced in both men and women, but remained above normal in women; Telles, 2011)
• C-reactive protein levels (primarily in women; the average levels in male participants more than doubled; Telles, 2011)

Yoga helps to improve:

• Range of motion and balance
• Chronic pain acceptance
• Mood
• Energy
• Relaxation
• Sleep quality
• Self-efficacy and confidence
• Vitality and general health
• Mindfulness
• Daily functioning
• Quality of life
• Hand grip strength (males only in one study; Telles, 2011)

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Benefits of Yoga for RA Patients

RA and Pain: Vitamin D Deficiency Masquerading as RA Disease Activity

Nobody would argue that rheumatoid arthritis is associated with pain. In fact, pain, tenderness, and swelling of the joints are some of the primary indications of disease activity. Nobody likes to hurt and reducing pain and associated tissue damage are goals of RA treatment.

Pain is often the brain’s way of telling us that something isn’t right; it can be an early warning signal of sorts. “Get your hands away from the fire before you seriously get burned!” The sensation of pain may indicate that we need to make a change in some way, e.g., physically, emotionally, spiritually. 

Pain may also be an indication that our body needs something it isn’t getting. For example, if I am not drinking enough water and begin to become dehydrated, I might get a headache, feel weak or dizzy, and have an upset stomach. And then there are times when nothing is wrong but you still feel pain, perhaps due to a malfunctioning nervous system that gets confused and sends misleading messages to/from the brain.

Several factors can influence how we perceive pain, one such factor is vitamin D deficiency which is measured by the 25(OH)D test. A recent study found that vitamin D deficiency was associated with higher pain intensity levels and lower quality of life in patients with widespread pain when compared with a control group. Researchers also found that lower vitamin D levels correlated with abnormal results from nerve conduction studies (Kuru, 2014).

Changes in vitamin D levels in the blood have been associated with inflammatory diseases, such as inflammatory bowel disease, rheumatoid arthritis, lupus, multiple sclerosis, atherosclerosis, or asthma (Wöbke, 2014). A 2012 meta-analysis, which included eight studies investigating the association between vitamin D and RA activity in 2,885 RA patients and 1,084 controls, revealed that the available evidence indicates that lower vitamin D levels are indeed associated with more RA disease activity as measured by DAS28 (disease activity score in 28 joints) (Song, 2012). Subsequent studies have found the same (Kostoglou-Athanassiou, 2012; Abourazzak, 2014; Hong, 2014).

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Vitamin D Deficiency and RA Activity

Is Medical Marijuana Effective Against RA Pain?

The use of medical marijuana remains a hot topic in the United States.  Although twenty states and the District of Columbia have enacted laws to legalize medical marijuana, in the majority of the country marijuana is still an illicit drug.  Two states, Colorado and Washington, legalized the recreational use of marijuana in 2012.  Despite state laws allowing for medical or recreational use of cannabis, the US federal government continues to list marijuana (cannabis) as a Schedule I substance under the Controlled Substance Act which makes it illegal to possess, use, or sell marijuana throughout the United States.

The Arthritis Foundation, an advocacy organization representing patients with all types of arthritis, featured a discussion on issues related to medical marijuana in its May/June 2013 issue of Arthritis Today. See “Medical Marijuana: RX or Risk?” (pdf) by Camille Noe Pagán.
- See more at: http://www.healthcentral.com/rheumatoid-arthritis/c/72218/168517/marijuana-pain#sthash.WqcLgwoe.dpuf

The use of medical marijuana remains a hot topic in the United States.  Although twenty states and the District of Columbia have enacted laws to legalize medical marijuana, in the majority of the country marijuana is still an illicit drug.  Two states, Colorado and Washington, legalized the recreational use of marijuana in 2012.  Despite state laws allowing for medical or recreational use of cannabis, the US federal government continues to list marijuana (cannabis) as a Schedule I substance under the Controlled Substance Act which makes it illegal to possess, use, or sell marijuana throughout the United States.

The Arthritis Foundation, an advocacy organization representing patients with all types of arthritis, featured a discussion on issues related to medical marijuana in its May/June 2013 issue of Arthritis Today. See “Medical Marijuana: RX or Risk?” (pdf) by Camille Noe Pagán.
RA Pain, Disease Activity, and Cannabis

In a phase II double-blind, randomized, placebo-controlled, 5-week study of 58 rheumatoid arthritis patients, researchers assessed the efficacy of Sativex administered at night up to a maximum of 6 sprays per evening (16.2 mg THC + 15 mg CBD) in 31 patients compared with placebo in 27 patients.  The primary outcome measure was morning pain on movement. Secondary outcomes included measures of pain at rest, sleep quality, morning stiffness, the Short-Form McGill Pain Questionnaire (SF-MPQ) and the 28-joint disease activity score (DAS28).  Baseline scores (an average of the last 4 days of a 14-day baseline period) were compared with the average of the last 14 days of treatment (Blake 2006).

Sativex produced statistically significant improvements in morning pain on movement, morning pain at rest, quality of sleep, disease activity (measured by DAS-28), and SF-MPQ pain at present, as compared to placebo.  However, researchers found that Sativex had no effect on morning stiffness in this group of RA patients (Blake 2006). Authors did point out that baseline scores for morning stiffness had been low initially.  No serious adverse effects occurred in the active treatment group and the large majority of adverse effects were mild or moderate, including dizziness, light-headedness, dry mouth, and nausea.  More studies are warranted.
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Can Medical Marijuana Help Reduce RA Pain?

"Walking on Rocks" and RA

Patients living with rheumatoid arthritis may experience symptoms which cannot be detected by just looking at their body.  Even squeezing and poking the tissues surrounding tender joints may not make swelling entirely obvious.  Doctors often have to trust that when we say, “ouch,” we really do mean it.

There have been times where one of my RA symptoms was the “walking on rocks” sensation in my feet.  Really quite unpleasant.  Some people might describe this sensation as walking on marbles or walking on pebbles.  Researchers at the University of Southampton aim to improve the health and mobility of RA patients who experience the “walking on marbles” pain. 

Last fall one of our health guides, V, asked, “Anyone else feel as though they are walking on rocks?”  Responses to her question reveal that this is truly a common complaint.

Investigators have developed new ways of using diagnostic ultrasound and MRI (magnetic resonance imaging) techniques to assess a patient’s feet, specially the area around the ball of the foot and toes.  Previously, it was thought that this pain was due to walking on joints which were directly affected by RA. 


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"Walking on Rocks": An Invisible Complication of RA

Don't Mix Methotrexate with Antibiotics

If you don’t know, it is very important to avoid taking antibiotics and methotrexate at the same time. There is an issue of toxicity of the methotrexate as antibiotics tend to prevent the complete break down of MTX. If MTX can’t be broken down appropriately, higher amounts may be found in the body.

I personally like to think of letting the methotrexate set aside (by not taking it) to allow the antibiotic soldiers to go in a do their duty (killing the infection). Fortunately this summer, the antibiotics I took for two weeks did just that. Unfortunately, the RA mischiefs decided that it would be a good time to act up a bit.

The pain started with an extra stiffness in my left hand. I thought that maybe I was typing too much or playing too many computer games where I hold my hand in a lose fist and typically use just one finger. But after a few days, it was my left foot which joined in the ‘party.’

Moving my toes became a practice in slow motion. When my boyfriend offered a foot rub which was so very sweet of him (and I wouldn’t ever want to turn down or discourage a foot rub), I couldn’t stand the pressure or even the gentle movement of toes. Ouch!! Stop!

Enter very unhappy Lisa face. Seriously, who turns down a foot rub?

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Antibiotics, Methotrexate, and RA Flare-Ups

Can't wait to get back on meds: Methotrexate and RA

I only have to wait until Saturday.  Two more days.  Saturday is the big day and it will arrive none too soon, I gotta tell ya.

"What happens Saturday?" you ask.

I will be off the antibiotics and can take methotrexate once again.  Whoohoo!

"Lisa, aren't you a little too excited about getting immuno-suppressed again?"

Nope.  Each day during this past week, I wake up and face just how much more my feet or hands hurt.  Little by little, it has been creeping up on me. 

Well, today.  I was so very tempted to dip into my emergency (MS relapse) supply of oral steroids which I took with me on vacation in June/July.  Just half a tablet would probably relieve some of this pain but somehow that seems an abuse of having it available.

"What's wrong with taking a little prednisone/decadron for your RA?"

Only once have I taken oral steroids for my RA, but that was before I was diagnosed with RA.  I took a medrol pack over a holiday season and when the taper ended, the pain came back full force.  It seemed to serve no real purpose than to prove something bigger was going on.

Last fall when I was getting monthly pulse steroids (1000mg prednisone by IV every four weeks), not only was my MS happier but my RA was thrilled.  I didn't really feel any substantial pain that I can recall.  It was very nice.

Well, the past three weeks have proven that the methotrexate really DOES help keep my RA under control.  That's the good news.

Now I just wonder how long it will take before my feet will stop feeling like they will break, my hips/knees will move smoothly again, and my knuckles will stop their slow swelling.  I hope that it works as quickly as it works well.

Besides the pain increasing, my brain is foggy.  I'm TIRED and have slept each afternoon for a couple of hours.  As a result, I haven't done my normal amount of writing/researching.  I'm slacking, I tell ya.

But the good news is that the inflammation/infection in my colon has been obliterated and I feel perfectly fine on that front.  Yay, antibiotics.

Hopefully everything will be back to normal soon.  I'm just very thankful that my RA is well controlled when I'm on all of my medications.  That's the best news!!